If you have signed Surity or Co-Debtor, Please indicate the full amount Outstanding:

I Confirm that:

A. I am not a minor.

B. I have never been declared mentally unfit by a court.

C. I am not subject to an administration order.

D. I do not have any current application pending for debt restructuring or alleviation.

E. I do not have any current debt re-arrangement in existence.

F. I have not previously applied for a debt re-arrangement.

G. I am not under sequestration.

H. I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act.

I. If any of the above is incorrect, give details:

I Agree to the above

Declaration by Client

I hereby grant the Credit Provider the right to communicate with me throught any electronic/written media or verbally in order to make available to me, their product offering

I hereby grant the Credit Provider the right to increase my Credit Limit once every year to accommodate ant Value Added Products needed and requested by me.

I hereby give consent to the Credit Provider to make enquiries about my credit record with anty credit agency and to obtain whatever information on me they might require to process the application. I also give consent to the Credit Provider to share my payment behaviour with any credit agency.